Barriers to Outpatient Hospital-Based Cardiac Rehabilitation in Korean Patients With Acute Coronary Syndrome

Abstract

ObjectiveTo investigate factors associated with enrollment and participation in cardiac rehabilitation (CR) in Korea.MethodsPatients admitted to four university hospitals with acute coronary syndrome between June 2014 and May 2016 were enrolled. The Cardiac Rehabilitation Barriers Scale (CRBS) made of 21-item questionnaire and divided in four subdomains was administered during admission. CRBS items used a 5-point Likert scale and ≥2.5 was considered as a barrier. Differences between CR non-attender and CR attender, or CR non-enroller and CR enroller in subscale and each items of CRBS were examined using the chi-square test.ResultsThe CR participation rate in four hospitals was 31% (170 of the 552). Logistical factors (odds ratio [OR]=7.61; 95% confidence interval [CI], 4.62–12.55) and comorbidities/functional status (OR=6.60; 95% CI, 3.95–11.01) were identified as a barrier to CR enrollment in the subdomain analysis. Among patients who were enrolled (agreed to participate in CR during admission), only work/time conflict was a significant barrier to CR participation (OR=2.17; 95% CI, 1.29–3.66).ConclusionDiverse barriers to CR participation were identified in patients with acute coronary syndrome. Providing the tailored model for CR according to the individual patient's barrier could improve the CR utilization. Further multicenter study with large sample size including other CR indication is required.

Treatment models of cardiac rehabilitation in patients with coronary heart disease and related factors affecting patient compliance

“…CHD has a serious impact on the quality of life and mental state of the patients (Dorje et al, 2018). The incidence of depressive symptoms in patients with CHD was reported to be 77.23% (Im et al, 2018). An abnormal psychological state can significantly increase the risk of cardiovascular events, disrupt the hypothalamicpituitary axis, affect endothelial cell function, and ultimately lead to increased myocardial oxygen consumption, thus aggravating or triggering the development of cardiovascular adverse events such as angina (Dalal et al, 2019).…”

Association between morbidity of non-communicable disease and employment status: a comparison between Korea and the United States

“…Americans with cardiovascular disease are more likely to undergo cardiac rehabilitation programs, which can prevent death or serious disabilities [23,24] and can accelerate the patient's return to work [25,26]. However, there might be obstacles to utilization of rehabilitation program for Koreans with cardiovascular disease due to limited coverage by the insurance system; also, limited sources [27,28] can prevent patients with cardiovascular disease from returning to work. Therefore, the possibility of return-to-work might be less in Korea than US.…”

Underutilization of Hospital-based Cardiac Rehabilitation after Acute Myocardial Infarction in Korea

“… 7 8 9 Nevertheless, CR participation rate after IHD has been low and shows disparities between countries 10 and individuals on account of various barriers. 11 According to a global report based on the responses of experts in CR from countries in 2017, and IHD burdens report from the Institute for Health Metrics and Evaluation, CR was available in only half of all countries, and the number of CR facilities for patients with IHD was insufficient in Korea. 12 13 The number of incident IHD cases per year per CR facility in Korea was 22, higher than the median value among countries worldwide (n = 21) and the mean of the Organization for Economic Cooperation and Development countries (n = 17).…”